The options for managing menopause

Mayo obstetrician-gynecologist Mary Marnach says if you're about to enter menopause, don't panic. It's not the beginning of the end.

"In 1900, the average Caucasian woman only lived to be in her upper 40s. Today, women who have fairly good health will live into their 80s and maybe beyond," says Marnach. "So today we're talking about these issues more because women live longer. And they have a right to live in a more healthful way than they have in the past."

There's a lot of confusion and myths about menopause, including when it begins. Technically, menopause begins at a woman's last menstrual period. But it isn't counted as the last one until a woman has gone a year without a period. So once a woman knows she's in menopause, she's actually post-menopausal. But the hot flashes, irritability and forgetfulness persist.

Marnach says many women approach menopause with a touch of fatalism. They say sex is over, weight gain is inevitable and hormones will be a mess. Marnach says it's true that menopausal women gain an average of 10-20 pounds, but not if they eat less and stay active.

Marnach says pain with sex, and a diminished libido are also common. Between 40 percent and 88 percent of menopausal women complain about sexual issues.

Marnach says hormones are a good solution for some women, and they can help with moodiness and clear thinking. The National Institutes of Health report most women use hormones for two to three years.

"I think there is a myth that that is entirely bad for women. And it really is not, especially if it's used at the correct time in a woman's life," says Marnach. "As you likely know, hormone therapy has not gotten the best rap the last few years, because of a large study done on women called the Women's Health Initiative."

In 1900, the average Caucasian woman only lived to be in her upper 40s. Today, women who have fairly good health will live into their 80s.

In that study, which began in 1992, 27,000 women enrolled in hormone therapy trials. They ended early after researches found women taking hormones were at greater risk for some diseases.

Women taking estrogen plus progestin were at increased risk of breast cancer, heart disease and blood clots. Taking the combination pill or estrogen alone increased the risk of stroke by 40 percent.

But doctors are now saying the study's results have to be taken in context. Many of the women in the study started taking hormones years after menopause. That's largely viewed as too late. The Mayo Clinic's Marnach believes taking hormones just as you enter menopause can reduce your risk for heart disease and osteoporosis.

Not every woman experiences menopause in the same way.

Sue Nash says menopause has been a nuisance. She's a nursing professor at Augsburg College in Rochester. She's experienced hot flashes and some irritability. But Nash doesn't use hormone therapy. Instead, she's changed the way she dresses and always carries a fan.

"I just packed away all my heavy Minnesota sweaters and turtlenecks, and anything that one would have to take over your head to take off," Nash says, "so that if I am speaking or teaching a class or holding a meeting, I can have a very lovely cape that I can just throw it on and take it off, and throw it on and take it off."

Drug company data shows that, as of May 2006, four million women were using hormone therapy. The National Institutes of Health say there's been a 40 percent drop in hormone therapy prescriptions since 2002, and the number is still falling.

Some of those women are likely looking to alternative medicines. A national survey shows that 36 percent of adults use alternative therapies. Herbal remedies are available without prescription, so there's no accurate count of how many women use them for menopause.

Marnach and doctors at the National Institutes of Health don't recommend herbal remedies. They say doctors don't know what these herbs do to the body long term.

But Chinese medical practitioner Jennifer Johnson says Chinese medicine is 2,000 years old. In the two years since she's opened her practice in Minneapolis, she's seen about 50 menopausal women. Johnson consulted recently with one woman about her symptoms.

Johnson says her goal isn't to put the hormones of a 30-year-old in the body of a 60-year-old.

"You're not just treating a specific hot flash that just happened, or one that's going to happen next week," Johnson says. "You try to prevent that from happening in the future. And that's the idea behind Chinese medicine, is getting the body to a place in balance where the symptoms start to decrease as time goes on."

Johnson recommends her menopausal patients change their lifestyle habits -- that they eat better, exercise regularly and pay attention to what their bodies are doing and feeling.

That message is appealing to Dawn Johnson, 51. She lives on a campground her family operates in Caledonia. Dawn Johnson stopped hormone therapy several years ago. She'd been using hormones for years, following a hysterectomy when she was 34.

Johnson says she tried a variety of patches and pills and synthetic pills. Her joints hurt and her back ached. Finally she said, enough, and quit. She wanted to take control of her body.

"There are some herbal options out there. I'm going to give it a try and see what I can do," Dawn Johnson says. "I fought with it for some time. I immediately went into hot flashes and night sweats, and it was pretty bad. It's really embarrassing when you're sitting talking to somebody, and you turn bright red and you start gushing water. It's gotten to the point where I've got it -- not completely under control, but I can control it so that I'm comfortable most of the time."

Johnson says she has the libido of a little girl. But she and her husband have found creative ways to be intimate.

Johnson has changed her lifestyle. Instead of coffee she drinks dandelion tea. She eats all organic food. She avoids caffeine, chocolate and alcohol, three items that are known to increase hot flashes. She also uses herbal supplements like Evening Primrose.

Johnson says her doctors all told her not to go off hormones. She was too young, and likely to get osteoporosis or heart disease.

"My joints feel better, my back feels better, so as far as osteoporosis, I think I'm actually healthier being off the synthetics than if I had stayed on them," says Johnson.

Instead, Johnson exercises and drinks whole milk. Doctors and alternative medical practitioners both say maintaining a healthy lifestyle will help the body's transition into menopause. It's the women, though, who are deciding the definition of health.

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